Associations between atrial natriuretic peptides, echocardiographic findings and mortality in an elderly population sample

Objectives. To examine associations of N-terminal and C-terminal components of the proatrial natriuretic peptide [ANP (1-98) and ANP(99-126), respectively], with echocardiographic measurements of left ventricular structure and performance and with the function of the aortic and mitral valves in old age. To compare the predictive value of the atrial peptides and echocardiographic data for short-term mortality. Design. A population-based survey with 1.5-year mortality follow-up. Setting. University hospital. Subjects. Three-hundred and thirty-three people aged 78-88 years. Main outcome measures. (i) Plasma ANP (1-98) and ANP(99-126); (ii) M-mode and Doppler echocardiographic measurements of left atrial diameter; left ventricular diameters, mass and fractional shortening; peak transmitral velocities; aortic valve area, aortic regurgitation jet length and mitral regurgitant jet area; (iii) total and cardiovascular 1.5-year mortality. Results. ANP (1-98) correlated with left atrial diameter (r = 0.33; P < 0.001), left ventricular mass (r = 0.19; P < 0.001), fractional shortening (r = -0.16; P < 0.01) and the early-to-atrial peak transmitral velocity ratio (r = 0.23; P < 0.001). Also, ANP(1-98) predicted the degree of aortic valve obstruction and the severity of aortic and mitral regurgitation. Associations of ANP(99-126) with echocardiographic data were much weaker. Aortic valve stenosis and ANP(1-98) were independent predictors of age-and sex-adjusted total and cardiovascular mortality at 1.5 years of entry. Conclusions. Circulating ANP (1-98) correlates with left atrial size, with left ventricular mass and performance and with the severity of aortic and mitral valve dysfunction in persons representing the general elderly population. ANP(1-98) also predicts both total and cardiovascular mortality.